Transcript Oral Hygiene Management Program- in Geriatric

Two dramatic demographic changes
in geriatric dentistry: 1900 - 2000
1. Increased numbers of adults surviving into older age.
2. Increased numbers of older adults retaining natural
teeth.
The “curve” of preventive dentistry!
Factors in keeping natural teeth:
Education
Nutrition
Medicine
Professional dental care
Genetic predisposition
Efficient home care
Cost of
dental plaque disease
Lifetime investment in
maintaining natural teeth can
be lost in a few months
Consequences of poor oral care
Tooth decay
Gum infection
Inability to chew food
Loss of teeth
Break down of teeth
And supportive tissue
Inflammatory
bacterial toxins
Systemic
infection
Cyclic fever
Consequences of poor oral care
Bad breath
Loss of self esteem
Social isolation
Reasons dependent elderly don’t
receive sufficient oral care:
Major illness
Medication that masks dental
disease
Cognitive and/or physical
decline
Income decline/uninsured
Inability to get to dentist
Impact of some medications on
awareness and progression of
oral disease:
Reduction of pain/sensitivity
Dry mouth
Antibiotics may mask origin of
dental plaque disease
Sedation
Top 10 causes of death in adults age
65 and over:
(1966 - US)
1: Heart Disease*
6: Diabetes Mellitus*
2: Malignant Neoplasms
7: Accidents and Adverse
Effects
3: Cerebrovascular
Diseases*
8: Alzheimer's Disease
4: Chronic Obstructive
9: Renal Diseases**
Pulmonary Disease**
10: Septicemia*
5: Pneumonia and Influenza**
» Chronic dental plaque disease*
(Source: Peter KD, Kochanec KD, Murphy SL.
Deaths: Final data for 1996. National Center for
Health Statistics. National Vital Statistics Rep
1998: 47: 27.)
* Strong co-factor
** Possible link
Top 10 chronic conditions in adults
age 65 and over:
(1994 - US)
1: Arthritis
2: Hypertension
3: Heart Disease*
4: Chronic Sinusitis**
5: Diabetes Mellitus*
6: Allergic Rhinitis
7: Varicosities
8: Hernia
9: Hemorrhoids
10: Chronic Bronchitis**
» Chronic dental plaque disease*
(Source: Adams PF, Movano MA. Current
estimates from the National Interview Survey.
1994. National Center for Health Statistics. Vital
Health Statistics 1995: 10: 83-84.
* Strong co-factor
** Possible link
Risks of Dental Plaque Disease on
(DPD) Dependent Elderly Health:
Aspiration pneumonia
Sepsis
Cardiac (co-factor)
Diabetes (co-factor)
Stroke (co-factor)
These conditions also have an impact on the
progression of dental plaque disease.
Healthy
Tooth
Dental Plaque
Disease
Healthy
Thick
protective
enamel
DPD
Healthy
DPD
Decay of enamel
Plaque & root
decay
Healthy
Tight membrane
normal passage
of fluids
DPD
Healthy
DPD
Loss of
membrane
Bacterial toxins
enter mouth
and body
Inflammatory
reaction
Healthy
Strong attachment
of fibers to bone
DPD
Healthy
DPD
Loss of support
structure
Inflamed
infected
gums
Oral Health Maintenance Elements
Mechanical
 Tooth brushing, flossing
Chemical
 Fluoride, anti-bacterial,
peroxide
Nutritional
 Healthy diet, fiber
Regular dentist visits
Oral Hygiene Management Program
Manual toothbrushes
 Small head
 Soft/medium bristles
 Children’s brushes work
well for older mouths
 Replace brushes routinely
Oral Hygiene Management Program
Battery spin brushes
 Inexpensive
 Easy to operate
 Gentle movement
* choose an easy-to-hold handle (kid’s brush perhaps)
* check for comfortable switch operation
Oral Hygiene Management Program
Cordless, rechargeable toothbrushes,
including ultrasonics
 Strong, effective action
 Ultrasonic action may bother some seniors
 Replace brushes routinely
* See Consumer Reports evaluations and recommendations
Oral Hygiene Management Program
Intradental Cleaning
 Daily flossing recommended
 Proxabrush may be helpful
 Stimudents or toothpicks may be
needed
 Ultrasonics
Oral Hygiene Management Program
Prescription products
 Fluoride gels*; brush on teeth at bedtime
without rinsing
 Chlorhexidine* (Peridex, Perioguard);
brush on morning after cleaning, do not
rinse
* Remove excess fluids by spitting or by sponge
Oral Hygiene Management Program
Nutritional considerations
 Avoid sugars
 Healthy diet
Regular dental visits
Oral Hygiene Management Program
Final thoughts
 Consistent oral care is the key
 DPD can be silent, painless
 Healthy mouth and healthy body go
together
 Resource list follows
Resources
“Providing Oral Care” (videotape),
Medcom Trainex (CNA #506), call 1800-877-1443
“Oral Care for the Dependent
Patient” (videotape), West Virginia
University Health Sciences School of
Dentistry and Geriatric Program, call
304-293-5912
Resources
“Assuring Dental Health for
Nursing Home Residents” (web
cast), Centers for Medicare and
Medicaid Services, see
http://cms.distributedclassroom.org
Resources
Oral Care in a Long-Term Care
Facility” (videotape), University
of Washington Instructional
Media Services, call 866-7911278 or see
http://www.dental.washington.edu/
conted/cdestore/longterm.htm
Resources
“A Beautiful Smile is Ageless”
(videotape) and “Oral Health
Assessment of Nursing Home
Residents: An In-Service Training
Guide for Nursing Staff” (videotape),
Greater Houston Dental Society, call
713-961-4337 or see
www.ghds.com/videos.htm